The overarching goal in seeking continuation of our status as a CCOP member is expansion of the variety and number of cancer treatment and control protocols available to patients of our largely rural service area which represents a minority population underrepresented in research with little opportunity for clinical trial access. Our 30 year track record in accruing patients to these trials and the renewed NCI focus on cancers screening and prevention clinical trials as well as NCI proposed quality care assessment, comparative- and cost-effectiveness outcomes research through the NCORP structure will provide Marshfield Clinic (MC) CCOP with unprecedented enrollment opportunities. Therefore, MC CCOP plans to increase accrual substantially over the next 5 year grant period contributing positively to NCI sponsored clinical research. To achieve these goals the MC CCOP proposes the following specific aims: 1) Engage in adult and pediatric clinical research related to screening, prevention and treatment of cancer appropriate to the population in and around the MC CCOP service area for which robust enrollment is anticipated, supported by historical data of cancer patterns in the MC CCOP service area. 2) Align the MC CCOP to the proposed NCORP model to position us for participation in NCORP studies, anticipated to be highly appropriate to the population residing in the MC CCOP service area; 3) Participate in NCI-proposed clinical research focused on examining quality parameters and effectiveness of current oncology care standards as an important strategy to ensure robust enrollment. The MC CCOP model will promote participation in classic phase ll/lll clinical trials and effective engagement of MC CCOP in complex multidisciplinary trials through the use of a patient centered approach that encompasses the full spectrum of cancer care including screening, quality assessment, cancer and symptom prevention, treatment, survivorship and comparative effectiveness research. The overarching significance of achieving these goals is the program's contribution to developing a new standard of clinical care which more fully incorporates research along the entire trajectory of patient care as encountered in daily clinical practice which is consistent with the stated NCI mission.